376 - Using cost conversations to address financial toxicity in pediatric asthma care: Findings from a survey of caregivers

Rising out-of-pocket asthma care costs are a key barrier for pediatric patients, leading to decreased adherence and suboptimal health outcomes. Asthma care teams are uniquely positioned to help caregivers address financial toxicity, although discussing the complex and sensitive topic of asthma care costs can be challenging.

Objective:

To characterize the prevalence and correlates of cost conversations in pediatric asthma specialty care clinics to inform future interventions to support asthma care teams.

Design/Methods:

In 2021, we surveyed 45 caregivers (48% non-Hispanic white) of children aged 4-17 with asthma. Eligible caregivers reported concern about asthma care costs and had recently accompanied their child to a visit at a multi-site asthma specialty practice in North Carolina. Guided by the Social Cognitive Theory, we assessed cost conversation behaviors, cognitions, and perceptions of the clinical environment. We used Fisher’s exact test to identify correlates of having a cost conversation.

Results:

About one-third of caregivers reported having had a cost conversation at their child’s asthma visit (36%). Cost conversations were less common among caregivers whose child had public versus private health insurance (16% vs 56%), who attended a telehealth versus in-person visit (6% vs 52%), or who did not versus did want a conversation (19% vs 77%, all p< .05). Non-Hispanic black, Hispanic, and other caregivers less often reported cost conversations than non-Hispanic white caregivers although this was not statistically significant (22% vs 52%, p=.06). Caregivers who had cost conversations most often reported discussing the cost of medication (100%) and equipment like nebulizers (63%); relatively few discussed indirect costs like transportation (13%). Most caregivers felt confident having cost conversations (91%) and perceived having sufficient time (89%) and privacy (90%) to do so. About half agreed cost seemed important to the asthma care team (53%). About one-third agreed the care team helped them better understand the cost of their child’s asthma care (34%).

Conclusion(s):

Our findings suggest relatively low prevalence of cost conversations in pediatric asthma specialty care, particularly for publicly insured patients and in the context of telehealth. Because caregivers reported predominately positive attitudes towards cost conversations, future research should explore opportunities to support asthma care teams in integrating cost conversations into routine pediatric asthma care to address financial toxicity.